JAMA Network Open reports that, "1 million women will fill a peripartum opioid prescription each year." Many of these women are also prescribed opioids during pregnancy.
One study tracking opioid-seeking behaviors in women who were prescribed opioids, from one week before birth and up to three days after, aimed to understand the effects of such prescriptions.
Opioids for Caesarian Sections
Over one-third of American women deliver by caesarian section per year. These women face the greatest risk of persistent opioid use.
Caesarian section, or c-section, requires an abdominal incision and is associated with longer hospital stays and increased postpartum physical complaints. A whopping 67% of these women receive an opioid prescription, compared to only 25% who deliver vaginally.
As mentioned, one million American women are prescribed a peripartum opioid. Though this number is significant, it is perhaps more relevant to note that one year later, 2.2% of those who delivered by caesarian and 1.7% who delivered vaginally were still taking opioids.
Filling an opioid prescription before delivery was the strongest predictor of ongoing use, but stronger initial dosing was also a significant risk factor, according to a study published in July.
To put these numbers in context, among new mothers not prescribed peripartum opioids, 1% who had caesarian deliveries and 0.5% who underwent vaginal delivery were also new opioid users.
Fortunately, it’s not all doom and gloom: prescription of peripartum opioids actually declined during the study years from 2008 to 2016.
Side Effects of Opioids During Pregnancy
According to the Mayo Clinic, opioid use during pregnancy typically doesn’t cause problems.
Opioids can, however, cross the placenta surrounding the fetus and enter the fetal nervous system. When opioids are taken close to the time of delivery, the newborn can suffer from slow and ineffective breathing, also known as respiratory depression.
Opioid dependency during pregnancy, on the other hand, can cause a host of serious and tragic outcomes, including placental problems, low birthweight, preterm labor and premature birth, birth defects, neonatal abstinence syndrome, in which the newborn goes through opioid withdrawal after birth, miscarriage, and fetal death.
Alternative Pain Management
Based on their findings, researchers are encouraging healthcare providers to be “judicious” in their opioid prescribing, to screen for those at risk of persistent use and to explore other pain management options.
Using long-lasting opioids for the height of birth pain as part of an epidural and reserving oral opioids for "breakthrough" post-birth pain is possible, lead author Alex Friedman Peahl, health researcher and University of Michigan obstetrician, said in a press release.
Acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs such as ibuprofen (Advil) can provide effective pain relief in the days after birth, Peahl said, especially if women receive education during birth preparation about their proper use.
If you’re concerned that you or someone you love has been prescribed or is currently taking an opioid medication, a list of common name brand and generic opioids can be found here.